Efficacy of meridian massage for motor function after a stroke: a systematic review and Meta-analysis

doi:10.19852/j.cnki.jtcm.2022.03.001

Abstract

Abstract:

OBJECTIVE: To evaluate the efficacy of meridian massage on motor function after a stroke.

METHODS: This systematic review and Meta-analysis of randomised (RCTs) and quasi-randomised controlled trials (qRCTs) was performed to determine the effects of meridian massage on motor dysfunction following a stroke. Articles published until December 2020 related to stroke and meridian massage from National Library of Medicine, Cochrane Central Register of Controlled Trials, Embase, KoreaMed, Japan science and Technology Agency, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database and China Science and Technology Journal Database were searched. The primary outcomes included Fugl-Mayer Assessment (FMA), modified Barthel Index (mBI) and clinical efficiency, while the secondary outcomes included modified Ashworth (mAS) and Berg Balance Scale (BBS). Two authors independently selected the literature, extracted the data and assessed the risk of bias, after which Meta-analysis with subgroups and sensitivity analysis was conducted.

RESULTS: A total of 16 RCTs and 3 q-RCTs involved 1556 patients satisfied the inclusion. Meta-analysis showed that compared to conventional rehabilitation, meridian massage had significantly better FMA [mean difference (MD) = 1.16, 95% confidence interval (CI): 0.43, 1.89, P = 0.002], FMA-L (MD = 3.21, 95% CI: 1.97, 4.45, P = 0.000 01), mBI (MD = 8.87, 95% CI: 4.24, 13.49, P = 0.000 02), clinical efficiency [relative risk (RR) = 1.37,95% CI: 1.24, 1.51, P < 0.000 01], mAS (MD = -0.69, 95% CI: -1.26, -0.11, P = 0.02) and BBS (MD = 5.07, 95% CI: 2.22, 7.93, P = 0.0005). Subgroup analysis indicated no significant difference between meridian massage and control group when the intervention duration was >8 weeks (MD = 0.89, 95% CI: -0.64, 2.42, P = 0.25) but improving motor function in the meridian massage when the intervention duration was ≤ 8 weeks (< 4 weeks intervention duration MD = 0.84, 95% CI: 0.59, 1.10, P < 0.000 01; 4-8 weeks MD = 2.41, 95% CI: 0.80, 4.01, P = 0.003).

CONCLUSIONS: Meridian massage as an alternative and complementary therapy seems to have short-term benefits in improving post-stroke motor function (particularly in the lower limbs), quality of life, clinical efficiency, and balance stability and muscle spasms. The high heterogeneity of the included studies and the low methodological quality certainly limits the confidence placed in this systematic review and Meta-analysis, warranting future well-designed studies.

Key words: stroke, meridian massage, motor function, Meta-analysis, randomized controlled trial

XIE Yunhui, GU Hao, ZHAO Qing, LI Dejie, GONG Ying, XIE Junxing, SHI Guofeng. Efficacy of meridian massage for motor function after a stroke: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2022, 42(3): 321-331.

Figures/Tables 10

References 51

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No.	Study	Country	Participates													Control		Duration	Outcome
No.	Study	Country	Total No. of random participates		Sex (M/F)	Type (Ischaemic stroke/ Haemorrhagic stroke/ Mixed stroke)			Age	Disease duration		Main content	Length of session/ frequency			Main content	Length of session/ frequency	Duration	Outcome
1	Di HY et al 2017²¹	China	150		T: 48/27 C: 46/29	T: 42/33 C: 39/36			T: 61.4 ± 5.2 C: 61.7 ± 5.3	< 3 m		Acupoint and meridian massage+ CR	2*15 min/d			CR	1*20 min/d	3 w	FMA, mAS, mBI, TCM Syndrome Score, Total efficacy
2	Lin JZ et al 2017²⁸	China	60		T: 10/20 C: 12/18	-		T: 62.04 ± 9.31 C: 60.86 ± 9.72		1-21 y		Acupoint and meridian massage + CR	5*40 min/w			CR	5*40 min/w	8 w	FMA, mBI, Total efficacy
3	Tang JL et al 2011³⁵	China	111		56/55	T: 41/15 C: 37/18		T: 52.4 ± 2.3 C: 53.1 ± 1.7		T: 13.6 ± 5.7(d) C: 14.5 ± 4.8(d)		Acupoint and meridian massage + CR	2*10 min/d			CR	-	3 w	mBI, Total efficacy
4	Wu XL et al 2018³⁷	China	70		35/35	-		T: 5074 C: 51-75		T: 2-12 w C: 2-11 w		Acupoint and meridian massage + CR	2*30 min/d			CR	2*30 min/d	4 w	mAS (data lack), Total efficacy
5	Sun PP et al 2015³⁴	China	60		T: 21/9 C: 25/5	60/0		45-75		1-5 m		Acupoint and meridian massage + CR	5*20 min/w			CR	5*20 min/w	3 w 90 d follow-up	FMA-U, FMA-L, mBI, Rankin
6	Yang YJ et al 2016³⁹	China	90		T: 34/11 C: 27/18	-		T: 59.93 ± 16.87 C: 62.73 ± 11.22		T: 3 ± 5 m C: 3 ± 7 m		Tuina therapy + CR	5*40-50 min/w			Placebo-Tui Na therapy (gentle rubbing) + CR	5*40-50 min/w	4 w, 3 m follow-up	FMA-U, FMA-L, mBI, mAS
7	Yue SJ et al 2012⁴¹	China	69		T: 19/16 C: 18/16	-		T: 68.1 ± 11.7 C: 68.8 ± 10.3		T: 27.8 ± 6.8 d C: 30 ± 5.4 d		Acupoint and meridian massage + CR	30mins/d			CR	-	1 m-hospital, 2 w-home, 2 m-follow-up	FMA, mBI
8	Wang XH et al 2015³⁶	China	104		T: 40/12 C: 38/14	-		T: 67.54 ± 11.35 C: 67.27 ± 11.23		-		Acupoint and meridian massage + CR	2*40-60 min/d			CR	-	10 d	FMA
9	Lee JS et al 2010³³	Korea	40		T: 10/10 C: 9/11	32/6/2		<50:3/1 50-59: 10/17 60-69: 3/2 >70:6/8		<14 d: 11/10 15-30 d: 11/13 31-56 d: 6/5		Acupoint and meridian massage + CR	40 min/d			Placebo massage + CR	30 min/d	2 w	Index finger circumstance, mBI, depression scale
No.	Study	Country	Participates									Treatment			Control			Duration	Outcome
No.	Study	Country	Total No. of random participates		Sex (M/F)	Type (Ischaemic stroke/ Haemorrhagic stroke/ Mixed stroke)		Age		Disease duration	Main content		Length of session/ frequency		Main content		Length of session/ frequency	Duration	Outcome
10	Hyun SK et al 2008²⁸	Korea	56		T: 14/14 C: 17/11	T: 16/12 C: 18/10		<50:5/3 51-60: 8/8 61-70: 10/12 >71: 5/5		<6 m: 6/7 6-12 m: 10/10 >12 m: 4/3	Acupoint and meridian massage + CR		10 min/d	CR			No detailed description	2 w	Grip power, Self-reported pain score ROM, index finger circumstance, mBI, depression scale
11	Yang M et al 2015³⁸	China	80	T: 25/15 C: 26/14		-	T: 62.9 ± 3.9 C: 63.0 ± 3.8			T: 2-13 m C: 3-13 m	Acupoint and meridian massage + CR		No detailed description	CR			3*10 min/d, 4d/w	3 m	FMA, mBI, Total efficacy
12	Zhang MN et al 2014³⁰	China	80	22/18		-	T: 53.6 ± 10.7 C: 48.5 ± 12.3			2 w-3 m	Acupoint and meridian massage + CR		2*40 min/d,5 d/w	CR			No detailed description	12 w	FMA-L, MT
13	Xu JJ et al 2009²⁶	China	166	T: 43/44 C: 49/30		T: 71/16 C: 72/7	T: 67.08 ± 9.42 C: 68.08 ± 9.43			2 w-6 m	Acupoint and meridian massage + CR		No detailed description	CR			No detailed description	4 w	FMA, mBI, CNS, SF-36, MMT, HAMA, HAMD
14	Wu PX et al 2010³²	China	100	T: 29/21 C: 37/13		T: 43/7 C: 42/8	T: 65.54 ± 11.03 C: 61.7 ± 9. 82			T: 11.9 ± 3.14 (d) C: 11.88 ± 4.24 (d)	Acupoint and meridian massage + CR		30 min/d	CR			Gradually increase time	3 m/6 m	NDS, mBI, SF-36 (modified)
15	Yang GP et al 2015²⁵	China	60	T: 19/11 C: 20/10		-	T: 52.13 ± 6. 95 C: 54.28 ± 7. 01			-	Acupoint and meridian massage + CR		2*40 min/d, 5 d/w	CR:			2*40 min/d, 5 d/w	8 w	FMA-L, MWS
16	Liu J et al 2012²⁹	China	60	38/22		38/22	57.3 ± 5.8			-	Acupoint and meridian massage + CR		30-50 min/d	CR			30-50 min/d	4 w	Brunnstrom, BBS, mBI
17	Wang YF et al 2002⁴⁰	China	27	T: 12/6 C: 7/2		-	T: 54.778 ± 12.436 C: 54.222 ± 13.517			< 6 m	Acupoint and meridian massage + CR		3*45 min/w	CR:			3*45 min/w	4 w	FMA, mAS, BI, Brunnstrom
18	Pang HP et al 2011³¹	China	80	T: 28/12 C: 26/14		-	T: 55.31 ± 7.54 C: 54.68 ± 8.21				Tui Na therapy + CR		240 min 5 d/w	CR			240 min5 d/w	8 w	FMA-L, MWS, gait analysis
19	Geng XD et al 2018²⁴	China	120	T: 29/31 C: 32/28		-	T: 58.2 ± 2.4 C: 57.8 ± 2.1			3-12 w	Tui Na therapy + CR		245 min 5 d/w	CR			245 min5 d/w	8 w	FMA-L, 6MWS, gait analysis

No.	Study	Country	Participates													Control		Duration	Outcome
No.	Study	Country	Total No. of random participates		Sex (M/F)	Type (Ischaemic stroke/ Haemorrhagic stroke/ Mixed stroke)			Age	Disease duration		Main content	Length of session/ frequency			Main content	Length of session/ frequency	Duration	Outcome
1	Di HY et al 2017²¹	China	150		T: 48/27 C: 46/29	T: 42/33 C: 39/36			T: 61.4 ± 5.2 C: 61.7 ± 5.3	< 3 m		Acupoint and meridian massage+ CR	2*15 min/d			CR	1*20 min/d	3 w	FMA, mAS, mBI, TCM Syndrome Score, Total efficacy
2	Lin JZ et al 2017²⁸	China	60		T: 10/20 C: 12/18	-		T: 62.04 ± 9.31 C: 60.86 ± 9.72		1-21 y		Acupoint and meridian massage + CR	5*40 min/w			CR	5*40 min/w	8 w	FMA, mBI, Total efficacy
3	Tang JL et al 2011³⁵	China	111		56/55	T: 41/15 C: 37/18		T: 52.4 ± 2.3 C: 53.1 ± 1.7		T: 13.6 ± 5.7(d) C: 14.5 ± 4.8(d)		Acupoint and meridian massage + CR	2*10 min/d			CR	-	3 w	mBI, Total efficacy
4	Wu XL et al 2018³⁷	China	70		35/35	-		T: 5074 C: 51-75		T: 2-12 w C: 2-11 w		Acupoint and meridian massage + CR	2*30 min/d			CR	2*30 min/d	4 w	mAS (data lack), Total efficacy
5	Sun PP et al 2015³⁴	China	60		T: 21/9 C: 25/5	60/0		45-75		1-5 m		Acupoint and meridian massage + CR	5*20 min/w			CR	5*20 min/w	3 w 90 d follow-up	FMA-U, FMA-L, mBI, Rankin
6	Yang YJ et al 2016³⁹	China	90		T: 34/11 C: 27/18	-		T: 59.93 ± 16.87 C: 62.73 ± 11.22		T: 3 ± 5 m C: 3 ± 7 m		Tuina therapy + CR	5*40-50 min/w			Placebo-Tui Na therapy (gentle rubbing) + CR	5*40-50 min/w	4 w, 3 m follow-up	FMA-U, FMA-L, mBI, mAS
7	Yue SJ et al 2012⁴¹	China	69		T: 19/16 C: 18/16	-		T: 68.1 ± 11.7 C: 68.8 ± 10.3		T: 27.8 ± 6.8 d C: 30 ± 5.4 d		Acupoint and meridian massage + CR	30mins/d			CR	-	1 m-hospital, 2 w-home, 2 m-follow-up	FMA, mBI
8	Wang XH et al 2015³⁶	China	104		T: 40/12 C: 38/14	-		T: 67.54 ± 11.35 C: 67.27 ± 11.23		-		Acupoint and meridian massage + CR	2*40-60 min/d			CR	-	10 d	FMA
9	Lee JS et al 2010³³	Korea	40		T: 10/10 C: 9/11	32/6/2		<50:3/1 50-59: 10/17 60-69: 3/2 >70:6/8		<14 d: 11/10 15-30 d: 11/13 31-56 d: 6/5		Acupoint and meridian massage + CR	40 min/d			Placebo massage + CR	30 min/d	2 w	Index finger circumstance, mBI, depression scale
No.	Study	Country	Participates									Treatment			Control			Duration	Outcome
No.	Study	Country	Total No. of random participates		Sex (M/F)	Type (Ischaemic stroke/ Haemorrhagic stroke/ Mixed stroke)		Age		Disease duration	Main content		Length of session/ frequency		Main content		Length of session/ frequency	Duration	Outcome
10	Hyun SK et al 2008²⁸	Korea	56		T: 14/14 C: 17/11	T: 16/12 C: 18/10		<50:5/3 51-60: 8/8 61-70: 10/12 >71: 5/5		<6 m: 6/7 6-12 m: 10/10 >12 m: 4/3	Acupoint and meridian massage + CR		10 min/d	CR			No detailed description	2 w	Grip power, Self-reported pain score ROM, index finger circumstance, mBI, depression scale
11	Yang M et al 2015³⁸	China	80	T: 25/15 C: 26/14		-	T: 62.9 ± 3.9 C: 63.0 ± 3.8			T: 2-13 m C: 3-13 m	Acupoint and meridian massage + CR		No detailed description	CR			3*10 min/d, 4d/w	3 m	FMA, mBI, Total efficacy
12	Zhang MN et al 2014³⁰	China	80	22/18		-	T: 53.6 ± 10.7 C: 48.5 ± 12.3			2 w-3 m	Acupoint and meridian massage + CR		2*40 min/d,5 d/w	CR			No detailed description	12 w	FMA-L, MT
13	Xu JJ et al 2009²⁶	China	166	T: 43/44 C: 49/30		T: 71/16 C: 72/7	T: 67.08 ± 9.42 C: 68.08 ± 9.43			2 w-6 m	Acupoint and meridian massage + CR		No detailed description	CR			No detailed description	4 w	FMA, mBI, CNS, SF-36, MMT, HAMA, HAMD
14	Wu PX et al 2010³²	China	100	T: 29/21 C: 37/13		T: 43/7 C: 42/8	T: 65.54 ± 11.03 C: 61.7 ± 9. 82			T: 11.9 ± 3.14 (d) C: 11.88 ± 4.24 (d)	Acupoint and meridian massage + CR		30 min/d	CR			Gradually increase time	3 m/6 m	NDS, mBI, SF-36 (modified)
15	Yang GP et al 2015²⁵	China	60	T: 19/11 C: 20/10		-	T: 52.13 ± 6. 95 C: 54.28 ± 7. 01			-	Acupoint and meridian massage + CR		2*40 min/d, 5 d/w	CR:			2*40 min/d, 5 d/w	8 w	FMA-L, MWS
16	Liu J et al 2012²⁹	China	60	38/22		38/22	57.3 ± 5.8			-	Acupoint and meridian massage + CR		30-50 min/d	CR			30-50 min/d	4 w	Brunnstrom, BBS, mBI
17	Wang YF et al 2002⁴⁰	China	27	T: 12/6 C: 7/2		-	T: 54.778 ± 12.436 C: 54.222 ± 13.517			< 6 m	Acupoint and meridian massage + CR		3*45 min/w	CR:			3*45 min/w	4 w	FMA, mAS, BI, Brunnstrom
18	Pang HP et al 2011³¹	China	80	T: 28/12 C: 26/14		-	T: 55.31 ± 7.54 C: 54.68 ± 8.21				Tui Na therapy + CR		240 min 5 d/w	CR			240 min5 d/w	8 w	FMA-L, MWS, gait analysis
19	Geng XD et al 2018²⁴	China	120	T: 29/31 C: 32/28		-	T: 58.2 ± 2.4 C: 57.8 ± 2.1			3-12 w	Tui Na therapy + CR		245 min 5 d/w	CR			245 min5 d/w	8 w	FMA-L, 6MWS, gait analysis

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